Nuclear Stress Test Questions

Medical Q&A [Moderated]
1

Hi

My friend at work is having a nuclear stress test (if that is the wrong name sorry) on Monday. He has to have some kind of medication to “simulate” stress because his physical condition precludes him going on a treadmill. I have 2 questions.

  1. Couldn’t they have people do some kind of barbell lift if they can’t run?

  2. One of our co-workers, who I shall dub "Mr. Nocebo, had this test before and is telling my friend how the medicine is horribly painful and you feel like your having a heart attack. Im guessing this is not normal and I can reassure my friend? (Mr. Nocebo is the same guy who tells us how sitting and eating bacon kills us like cancer.)

Thanks!

2
  1. Nope. This idea:

a) Introduces a significant skill component, which takes time to learn. Who is going to coach the lifts to all these patients needing stress tests every day?

b) Is an activity that is not limited by cardiac output (unless you make it extremely submaximal for an extremely high number of reps - i.e., an endurance effort). If you used a standard heavier weight for a set of 1-5 reps, you might be physically too weak to lift the weight, but your cardiac function may be fine … so your heart rate never gets high enough to give us useful information during the test.

There are several other problems with this from a testing sensitivity and logistical standpoint.

  1. He likely had a stress test using a medication like adenosine or regadenoson. These medications can, in fact, cause significant chest discomfort upon administration in a significant proportion of individuals. However, when I talk to patients about this I do not use language like “horribly painful” and “you’re going to feel like you’re having a heart attack”.
3

Okay thanks!

4

Sorry one other question. Do you have any suggestions on a better way I can describe it to my friend to hopefully reduce some of the Nocebo?

I’m sure it is difficult to describe something you havent experienced but I’m also confident you are good at reassuring nervous patients.

oh yeah…and do you know any good recipes or drugs we can dip blow darts in to shoot into people who seem to derive pleasure from spouting off nocebo?

5

Now that he knows about that side effect, I would acknowledge it, but also say that it’s very transient and is not harmful.

The more he can remind himself of this during the procedure, the better.

6

I talked to him before we left work and he said he was going to shoot a video of himself being calm and relaxed and show it to Mr. Nocebo:)